1. Name  14 February 2007Durham LINKS  17th January 2013 Hot and Cold Extremes

2. Heat Extremes  Durham LINKS  17 th January 2013 Getting too hot… Heat Exhaustion Heat Stroke

3. Heat Extremes  Durham LINKS  17 th January 2013 The Largest Organ in the Body The Skin! Why do we have skin? Epidermis Dermis Fatty Tissue

4. Heat Extremes  Durham LINKS  17 th January 2013 Skin – The Epidermis The outermost layer Varies in thickness Cells travel up through the epidermis, taking about 4 weeks

5. Heat Extremes  Durham LINKS  17 th January 2013 Skin – The Dermis Sweat glands Sebaceous (oil) glands Hair follicles Blood vessels Specialised nerve endings

6. Heat Extremes  Durham LINKS  17 th January 2013 Skin – Fatty Bit (Subcutaneous Layer) Between the dermis and the muscles/other deeper structures Insulates An energy store

7. Heat Extremes  Durham LINKS  17 th January 2013 How bad is the burn? 3 key severity indicators:  How deep is the burn?  What is the extent of the burn?  Where is the burn?

8. Heat Extremes  Durham LINKS  17 th January 2013 Superficial (1 st Degree) Involve only top layer of skin Skin turns red but doesn’t blister or burn through Tender and painful Sunburn is a good example

9. Heat Extremes  Durham LINKS  17 th January 2013 Partial Thickness (2 nd Degree) Involves epidermis and some portions of dermis Doesn’t destroy entire thickness of skin Moist, mottled and white to red Blisters with severe pain Causes could include scalds from boiling water or fat.

10. Heat Extremes  Durham LINKS  17 th January 2013 Partial Thickness (2 nd Degree)

11. Heat Extremes  Durham LINKS  17 th January 2013 Full Thickness (3 rd Degree) Extends through all skin layers and may involve other structures Area dry and leathery Appear white, dark brown or charred Pain (although possibly not in centre) Caused by prolonged exposure to heat source

12. Heat Extremes  Durham LINKS  17 th January 2013 Full Thickness (3 rd Degree)

13. Heat Extremes  Durham LINKS  17 th January 2013 Extent The size of area affected Patient’s palm is approx. 1% of total body surface area

14. Heat Extremes  Durham LINKS  17 th January 2013 When to call 999? Golden Rule: If unsure, call an ambulance Medical attention should be sought for any children or more elderly burns victims. ALL full thickness burns (skin grafts will be needed) ALL burns affecting face, hands, feet, or genital area Burns that extend all the way round an arm or leg All partial thickness burns covering greater than 1% of the body All superficial burns covering greater than 5% of the body

15. Heat Extremes  Durham LINKS  17 th January 2013 Treatment Primary Survey! (DRSABC) If necessary, treat for shock Stop the burning process Keep Patient Warm Prevent risk of infection Obs

16. Heat Extremes  Durham LINKS  17 th January 2013 Stop the burning… Pour cold water onto the burn for at least 10 minutes Keep patient warm Cover to reduce infection risk

17. Heat Extremes  Durham LINKS  17 th January 2013 Any questions (Burns)? Burns

18. Heat Extremes  Durham LINKS  17 th January 2013 Moving to the Cold Side…

19. Heat Extremes  Durham LINKS  17 th January 2013 Factors to consider Different factors affect how a person reacts to an extreme heat exposure:  Physical condition  Age  Nutrition and hydration  Environmental conditions

20. Heat Extremes  Durham LINKS  17 th January 2013 A Bit of Physics… Heat only moves from hot to cold Body can lose heat by the following:  Conduction  Convection  Evaporation  Radiation  Respiration

21. Heat Extremes  Durham LINKS  17 th January 2013 Hypothermia ‘low temperature’ Normal body temp is 37 degrees Core temperature < 35 degrees C As Temp lowers body functions begin to slow

22. Heat Extremes  Durham LINKS  17 th January 2013 Signs and Symptoms Core Temperature34-35C32-33C27-31C<27C Signs and Symptoms Shivering, foot stampting Loss of coordination, muscle stiffness ComaApparent death Cardiorespiratory Response Constricted blood vessels, rapid breathing Slowing resps, slow pulse Weak pulse, arrhythmias, very slow resps Cardiac Arrest Level of Conciousness WithdrawnConfused, lethargic, sleepy Unresponsive

23. Heat Extremes  Durham LINKS  17 th January 2013 Local Cold Injuries Exposed extremities are particularly vulnerable Frostnip/chilblains/immersion foot Frostbite

24. Heat Extremes  Durham LINKS  17 th January 2013 Treatment Primary Survey! Two types of warming:  Active rewarming  Passive rewarming

25. Heat Extremes  Durham LINKS  17 th January 2013 Any Questions (Coldness)? Cold

26. Heat Extremes  Durham LINKS  17 th January 2013 Back to the Hot Side

27. Heat Extremes  Durham LINKS  17 th January 2013 Hyperthermia ‘high temperature’ Normal body temp = 37 degrees Effects of hyperthermia often happen above a core temp of about 38.3 degrees 3 main hyperthermia problems:  Heat Cramps  Heat Exhaustion  Heat Stroke

28. Heat Extremes  Durham LINKS  17 th January 2013 Heat Cramps Painful muscle spasms Occur often after vigorous exercise Exact cause unclear Often in leg and abdomen

29. Heat Extremes  Durham LINKS  17 th January 2013 Heat Exhaustion Number of causes Hypovolemia due to profuse sweating For sweating to work…must evaporate!

30. Heat Extremes  Durham LINKS  17 th January 2013 Heat Exhaustion – Signs and Symptoms Dizziness Weakness Faint Altered level of AVPU Nausea Vomiting Headache Muscle Cramps Profuse Sweating Flushed skin Dry tongue and thirst Low Diastolic Dilated pupils Slightly elevated core temp. Onset during exercise in hot/humid/poorly ventilated environment Onset at rest for young/old

31. Heat Extremes  Durham LINKS  17 th January 2013 Heat Stroke More serious that heat exhaustion Rapid rise in core body temp. Body’s cooling mechanisms totally overrun Heat + Stroke = Heat Stroke?

32. Heat Extremes  Durham LINKS  17 th January 2013 Heat Stroke- Signs and Symptoms Initially the same as heat exhaustion Develops to:  Hot, dry flushed skin  Constricted Pupils  Change in behaviour  Possible seizures  Pulse initially rapid and strong but then weakens  BP falls  Resps Increase  Sweating stops  Will end in unresponsiveness (could be rapid)

33. Heat Extremes  Durham LINKS  17 th January 2013 Treatment – Heat Cramps Primary Survey! Remove Pt from hot environment Loosen any tight clothing Consider O2 as necessary Rest cramping muscles Replace Fluids  Don’t use salt tablets or high salt solution Cool Pt with water spray/mist or fan Pt Do they need further help?

34. Heat Extremes  Durham LINKS  17 th January 2013 Treatment – Heat Exhaustion Primary Survey! Remove excessive clothing, particularly around head and neck Move to cooler environment Consider O2 therapy Cool Pt – splash with cool (not ice) water and fan Encourage to lie down and raise legs If alert – rehydrate Symptoms should get better promptly…else hosp!

35. Heat Extremes  Durham LINKS  17 th January 2013 Treatment - Heat Stroke Primary Survey Move to cooler environment Lower body temperature ‘by any means possible’ Remove clothing Consider O2 therapy Apply cool things to body Cover with wet towels or sheets or spray with cool water Needs 999!

36. Heat Extremes  Durham LINKS  17 th January 2013 Any Questions (Heat)? Heat

37. Heat Extremes  Durham LINKS  17 th January 2013 To Summarise…